Healthcare Provider Details

I. General information

NPI: 1871028928
Provider Name (Legal Business Name): PRIYANK DESAI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date: 04/14/2022
Reactivation Date: 05/09/2022

III. Provider practice location address

89 SPARTA AVE
SPARTA NJ
07871-1777
US

IV. Provider business mailing address

1458 HURON RD
NORTH BRUNSWICK NJ
08902-1508
US

V. Phone/Fax

Practice location:
  • Phone: 973-729-2121
  • Fax:
Mailing address:
  • Phone: 848-228-9685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number25MB12628200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: